Why preventive care is important

Remember the old saying that "an ounce of prevention is worth a pound of cure"? This can be especially true when it comes to preventive health care. Maintaining or improving your health is important - and a focus on regular preventive care, along with following the advice of your doctor, can help you stay healthy.

Troll of transplantation

Definition
Cytomegalovirus (CMV) is a member of a group of herpes-type viruses that can cause an infection of the lungs in immune-suppressed persons. This infection is particularly common in solid organ transplant and bone marrow transplant recipients.

Causes, incidence, and risk factors

Infection with CMV is very common. The majority of healthy adults have antibodies (an indication of previous infection) to CMV in their blood.

Usually CMV produces no symptoms, but serious CMV infections can occur in people with impaired immunity, such as those with AIDS, organ transplant and bone marrow transplant recipients, and people receiving chemotherapy or other immunosuppressive treatments.

CMV disease is a common complication of organ transplantation. CMV pneumonia occurs in 20% of bone marrow transplant recipients. Risk of infection is greatest from 5 to 13 weeks after transplantation.

Complications of CMV infection in individuals with AIDS include: an infectious mononucleosis-like illness (CMV mononucleosis), CMV pneumonia, inflammation of the retina (CMV retinitis), and intestinal disease. In addition, CMV may increase the replication of HIV in infected individuals.

CMV pneumonia is associated with fever, a non-productive cough and shortness of breath (dyspnea). CMV pneumonia is often present simultaneously with pneumocystis pneumonia. Decreased oxygen levels in the blood (hypoxemia) in association with CMV pneumonia often predicts a fatal outcome.

Symptoms

cough

shortness of breath

shortness of breath on exertion

fever

general discomfort, uneasiness, or ill feeling (malaise)

loss of appetite

fatigue

sweating, excessive (night sweats)

muscle aches or joint pains

Signs and tests

urine culture (clean catch)

blood culture

CMV serology by IFA

bronchoscopy with biopsy, stains, and culture for CMV

chest X-ray

arterial blood gas

Treatment

The objective of treatment is to stop the replication of the virus within the body through the use of antiviral agents, such as ganciclovir or foscarnet. Oxygen therapy and ventilatory support may initially be necessary to maintain oxygenation until the infection is brought under control.

Expectations (prognosis)

Antiviral medications stop the replication of the virus, but do not destroy it. CMV is, in itself, immunosuppressive and may increase the risk of other infections due to the additive immunosuppression.

Complications

relapse of infection

overwhelming infection not responsive to treatment

low white blood cell count with use of ganciclovir

kidney impairment with use of foscarnet

Calling your health care provider

Call your health care provider if symptoms of CMV pneumonia occur.

Prevention

Use of CMV-negative donors for seronegative recipients of organ transplants, use of CMV-negative blood products for transfusion, and CMV-immune globulin in certain patients has shown some preventive effects. Prevention of AIDS avoids opportunistic diseases, including CMV, associated with a damaged or incompetent immune system.

Last revised: December 4, 2012by Janet G. Derge, M.D.

Medical Encyclopedia

All ArmMed Media material is provided for information only and is neither advice nor a substitute for proper medical care. Consult a qualified healthcare professional who understands your particular history for individual concerns.

It's easy to make a financial decision based on what you need right now, but making an informed choice will benefit you in the long run. Meet a former Red Sox pitcher who picked security over an uncertain future